Atypical presentation of glioma tumor: autopsy results

Abstract

Background: A brain tumor can appear in post-ischemic areas, and due to increased proliferation, venous thrombosis, hypercoagulability, and local factors it can induce stroke. These two conditions can mimic each other. The aim of the study was to analyze the missed cerebral glioma cases due to atypical presentation. Material and methods: A retrospective analysis of autopsy protocols from 2017 till 2019 was performed and 17 cases of glioma clinically missed but identified at necropsy were selected. Results: The mean age was 59.116 ± 14.33 years, mean hospital stay 23.8 ± 23.5 days, undergone surgeries 41.2% of cases. Cardiovascular risk factors: hypertension – 88.2%, diabetes – 29.4%, obesity – 23.5%, ischemic heart disease – 58.8% and history of stroke – 17.6%. Imaging described as ischemia – 56.3% of cases, hemorrhage – 47.1%, infections – 11.8%, multiple lesions – 52.9%. Tumor was suspected just in 23.5% of cases. Established discharge diagnoses: hemorrhagic stroke – 29.4%; ischemic stroke – 29.4%; ICH – 11.8%, CNS infections – 17.6%; tumor with another location – 11.8%. Histology confirms grade II gliomas in 11.8%, grade III – 29.4%, and grade IV – 58.8% according to the WHO classification. There was also detected during necropsy associated hemorrhagic stroke in 29.8% of cases, ischemic stroke – 11.8% or infection in 50% of cases. Conclusions: The study showed that gliomas can present atypically from clinical and imaging point of view as ischemic or hemorrhagic stroke, which suggests the need to follow a well-established diagnostic protocol and increased awareness.